Registration and Payment Form 

Note: Early Bird Deadline 30 March 2012  

Please provide the following contact information

Name
Organisation
Work Phone
Email

Address
Address
State	Please choose QLD NSW ACT VIC TAS SA WA NT N/A
Postcode
Country

Please describe your current role and your interest in this event:

TYPE OF REGISTRATION	Fee (includes GST)
		Early Bird before 30 March 2012	Standard after 30 March  2012
Individuals, users of services (self-funded)		$77	$99
Groups (self-help, advocacy, community)		$220	$330
Service providers		$396	$473
Academics, researchers		$396	$473
Commercial (trainers, consultants, planners)		$440	$550
Government		$550	$660
One day registration is available at 75% of the applicable rate

I will be attending as a

          Please choose Unfunded individual, user of services Group - self-help, community or advocacy Service provider Academic, researcher Commercial trainer, consultant or planner Government employee
 

Payment Options Please reserve my place and

	I will send my cheque/money order to  Social Enterprise Partnerships
		PO Box 159
		Yarraville VIC 3013
		(Cheque payable to Social Enterprise Partnerships)
OR

	I will pay by EFT transaction:	Bank: Commonwealth Bank of Australia Account name: Social Enterprise Partnerships Ltd BSB: 062 218 Account number: 1007 2945
	Please send a tax invoice.

I have read, and accept the terms and conditions described below.

Terms and Conditions 1. Registration fees must be paid in full before the date of the event. 2. Cancellations must be notified in writing by 27 April, 2012. For cancellations received after 28 April, full fees will apply. 4. Transfer of registration is permitted where necessary, to enable another person from the same organisation/department/group to attend the event in place of the person whose name is shown on the registration form. (Should you wish to take up this option, please advise  on the change of name and contact details before the date of the event.) 5.. Privacy Statement: Registration details will be held in the strictest confidence and will not be passed onto a third party without the express permission of the attendee. Social Enterprise Partnerships Ltd ABN 47108742098 PO Box 159 Yarraville Vic 3013